Race Impacts Subspecialty Care in Autism

Action Points

Subspecialty care for comorbidities in autism may be falling short for non-white children, even among those seen at a major academic center.

Point out that African-American, Hispanic, and other non-white children were 38% to 68% less likely to see specialists for gastrointestinal and nutrition services, neurology, and psychiatry or psychology services.

Subspecialty care for comorbidities in autism may be falling short for non-white children, even among those seen at major academic centers, researchers found.

Although 37% of white and Hispanic kids with autism visited a subspecialist, that rate was 30% among African-American patients, Sarabeth Broder-Fingert, MD, of Boston's Massachusetts General Hospital (MGH) for Children, and colleagues found in that center and its affiliates.

African-American, Hispanic, and other non-white children were 38% to 68% less likely to see specialists for gastrointestinal and nutrition services, neurology, and psychiatry or psychology services, they reported in the July issue of Pediatrics.

It's possible that comorbidities differ across racial and ethnic backgrounds, but disparities in referral rates or referral follow through are possible too, the group pointed out.

The incidence of autism is the same across racial and ethnic groups, Reymundo Lozano, MD, PhD, a pediatric geneticist at the University of California Davis MIND Institute, commented in an interview with MedPage Today.

"It is critical for parents to advocate for their children and to request referrals and follow-through to get the final consultation," he said. "Those referrals and consultations will mean early diagnosis, early intervention, and better outcomes for patients, families, and our communities."

Around 30% of autistic kids have other psychiatric issues, like anxiety or attention-deficit hyperactivity disorder (ADHD), while 40% to 80% have trouble sleeping, 17% to 85% have GI problems, and 5% to 38% have epilepsy.

"Developing clearer practice guidelines based on evidence of the benefit of specific evaluations and procedures may help," Broder-Fingert's group suggested.

The study included 3,615 autism patients, ages 2 to 21, at MGH or its affiliate health centers, among whom 7% were Hispanic, 5% were African-American, and 7% had other non-white backgrounds.

Compared with white kids, the odds of seeing a GI or nutrition subspecialist were significantly lower, at 0.32 for both African Americans and Hispanics and 0.56 for others.

Colonoscopy was 77% less likely for African Americans and 74% less likely for Hispanics with autism.

Endoscopy was similarly 69% less likely for African Americans, 73% less likely for Hispanics, and 47% less likely for other non-white kids with autism compared with whites. Stool studies were half as likely for African Americans.

For neurology, the odds ratio of any visit was 0.52 for African Americans and 0.40 for Hispanics, both statistically significant.

Psychiatry or psychology visit ORs were 0.44 for African Americans, 0.60 for Hispanics, and 0.62 for others compared with whites in the study.

Hispanics in particular were less likely to undergo testing for neurologic comorbidities compared with whites, with odds that were:

47% lower for electroencephalography (EEG)

38% lower for brain MRI

82% lower for sleep studies

45% lower for neuropsychiatric testing

African Americans also had 63% lower odds of brain MRI testing.

Limitations of the study included use of administrative billing codes, exclusion of patients with Asperger's syndrome or pervasive developmental disorder-not otherwise specified, and analysis of the limited population of a single center.

The challenges may be even greater for minority families trying to get subspecialty care in community centers than in the large academic setting studied, Lozano noted.

Broder-Fingert and colleagues reported no conflicts of interest.

A co-author reported an unrestricted grant from the Nancy Lurie Marks Foundation to support policy research in autism spectrum disorder, as well as from Autism Speaks for support for related work.

Lozano reported having no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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